Third-Line Rescue Therapy with Bismuth-Containing Quadruple Regimen After Failure of Two Treatments (with Clarithromycin and Levofloxacin) for H. pylori Infection

Gisbert, Javier P.; Pérez-Aísa, Ángeles; Rodrigo, Luı́s; Molina–Infante, Javier; Modolell, Inés; Bermejo, Fernando; Castro‐Fernández, Manuel; Antón, Rosario; Sacristan, B.; Cosme, Ángel; Barrio, Jesús; Harb, Yamal; González-Bárcenas, Martha Lucia; Fernandez-Bermejo, Miguel; Algaba, Alicia; Marín, Alicia C; McNicholl, Adrián G.

doi:10.1007/s10620-013-2900-x

Cited by 47 publications

(29 citation statements)

References 45 publications

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“…Although compliance (PP=97%) was comparable to that observed here, treatment duration, PPI, doses of antibiotics, and bismuth were highly heterogeneous. This variability, besides geographic differences and the different composition of Pylera ® ‐bismuth salt, could explain the lower eradication rates …”

Section: Discussionmentioning

confidence: 99%

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

et al. 2017

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“…On the other hand, empirical treatment after two failed attempts has shown heterogeneous results: 65-85% with bismuth-containing quadruple therapies [Hsu et al 2008;Gisbert et al 2014], 60-90% with levofloxacin-based therapy [Sereni et al 2012;Tursi et al 2012;Gisbert et al 2006;Zullo et al 2003a] and 62-95% with a rifabutinbased therapy associated with PPIs and amoxicillin [Lim et al 2014;González et al 2007]. The studies differ in terms of previously administered therapies, study populations and drug schedules.…”

Section: Discussionmentioning

confidence: 99%

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Puig

López-Góngora

Calvet

et al. 2016

Therap Adv Gastroenterol

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Background: Susceptibility-guided therapies (SGTs) have been proposed as preferable to empirical rescue treatments after two treatment failures. The aim of this study was to perform a systematic review and meta-analysis evaluating the effectiveness and efficacy of SGT as third-line therapy. Methods: A systematic search was performed in multiple databases. Studies reporting cure rates of Helicobacter pylori with SGT in third-line therapy were selected. A qualitative analysis describing the current evidence and a pooled mean analysis summarizing the cure rates of SGT in third-line therapy was performed. Results: No randomized controlled trials or comparative studies were found. Four observational studies reported cure rates with SGT in third-line treatment, and three studies which mixed patients with second-and third-line treatment also reported cure rates with SGT. The majority of the studies included the patients when culture had been already obtained, and so the effectiveness of SGT and empirical therapy has never been compared. A pooled mean analysis including four observational studies (283 patients) showed intention-to-treat and perprotocol eradication rates with SGT of 72% (95% confidence interval 56-87%; I 2 : 92%) and 80% (95% confidence interval 71-90%; I 2 : 80%), respectively. Conclusions: SGT may be an acceptable option as rescue treatment. However, cure rates are, at best, moderate and this approach has never been compared with a well-devised empirical therapy. The evidence in favor of SGT as rescue therapy is currently insufficient to recommend its use.

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“…However, the case of a multi-resistant H. pylori strain successfully treated with minocycline/amoxicillin/bismuth has been described [14]. Tetracycline has been employed in third line regimens, enclosed in classical bismuth-containing quadruple therapy, with results varying from 65% in a recent Spanish trial [15] to 36% in another study conducted in the year 2000 in the same country [16].…”

Section: Discussionmentioning

confidence: 99%

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

Ierardi

Giangaspero

Losurdo

et al. 2014

JGLD

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Background & Aims: Antibiotic resistance is the main reason for failure of Helicobacter pylori (H. pylori) treatment. Currently, guidelines recommend a treatment guided by antimicrobial susceptibility testing after two failures. However, microbial culture is not feasible everywhere, and the limited number of effective antibiotics against the bacterium narrows the options; thus a rescue therapy combining antibiotics with a low resistance may be fitting.Methods: Patients who have failed a first-line treatment (either prolonged triple or sequential regimens) and, successively, a levofloxacin-based triple therapy were considered for the study. Subjects underwent urea breath test (UBT), stool antigen test (ST) and endoscopy/histology to confirm the diagnosis. Cytopenia and impaired liver and kidney function were exclusion criteria. Fifty-four subjects were randomized 1:1 to two regimens: RMB Rabeprazole/Rifabutin/Minocycline/Bismuth sub-citrate or MTB Rabeprazole/Tinidazole/ Minocycline/Bismuth sub-citrate both for 10 days. The results were checked 6 weeks after the end of therapy with ST/UBT plus endoscopy when indicated.Results: RMB eradicated the bacterium in 21 patients. Two subjects dropped out. The eradication rate was 77.7% (CI 62.0-93.4%) at intention-to-treat and 84.0% (CI 69.6-98.4%) at per-protocol analysis. MTB was successful in 14 patients (51.9%, CI 33.1-70.7%). No patient withdrew from the treatment for adverse events. Drug-related side effects were reported only in 3 subjects, but in all cases the treatment was carried on.Conclusions: The association minocycline/rifabutin seems to have a synergic effect and a good therapeutic outcome in patients who have failed at least two previous regimens, although a trial on a large population is needed.

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Third-Line Rescue Therapy with Bismuth-Containing Quadruple Regimen After Failure of Two Treatments (with Clarithromycin and Levofloxacin) for H. pylori Infection

Abstract: A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.

Cited by 47 publications

References 45 publications

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

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Third-Line Rescue Therapy with Bismuth-Containing Quadruple Regimen After Failure of Two Treatments (with Clarithromycin and Levofloxacin) for H. pylori Infection

Abstract: A bismuth-containing quadruple regimen is an acceptable third-line strategy and a safe alternative after two previous H. pylori eradication failures with standard clarithromycin- and levofloxacin-containing triple therapies.

Cited by 47 publications

References 45 publications

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

Systematic review: third-line susceptibility-guided treatment for Helicobacter pylori infection

Quadruple Rescue erapy aer First and Second Line Failure for Helicobacter pylori Treatment: Comparison between Two Tetracycline-Based Regimens

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Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study

Limited effectiveness with a 10‐day bismuth‐containing quadruple therapy (Pylera^®) in third‐line recue treatment for Helicobacter pylori infection. A real‐life multicenter study